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General NPI Number Information
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NPI Number | 1124149067
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Entity Type | Organization
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Legal Business Name | ARKANSAS VALLEY COMMUNITY CENTER
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1500 SAN JUAN AVE
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City | LA JUNTA
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State | CO
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Zip | 81050-2834
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Country | US
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Telephone | 719-384-8741
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1130
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City | LA JUNTA
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State | CO
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Zip | 81050-1130
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Country | US
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Telephone | 719-384-8741
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE EXECUTIVE DIRECTOR
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Name | ROSA M SALO
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Credential |
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Telephone | 719-384-8741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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